Republicans Double Down on Bribery to Pass Unpopular Bill

With the G.O.P.’s final attempt to repeal Obamacare on life support after Senator John McCain declared that he would vote “no” on the latest legislation, Republican leadership released a new version of their bill on Sunday that includes revisions designed to convince a handful of skeptical lawmakers to throw their support behind a remarkably unpopular bill. A new poll published Monday shows that Graham-Cassidy, named after co-sponsors Lindsey Graham and Bill Cassidy, is approved by just 20 percent of Americans and only 46 percent of Republicans. Which makes it all the more telling that Graham and Cassidy are trying to bribe two key holdouts—Senators Lisa Murkowski of Alaska and Susan Collins of Maine—by promising to partially spare their states from some of the worst impacts of the bill. According to a report from The Washington Post, the latest draft shows Alaska would get 3 percent more federal health-care funding than under the Affordable Care Act between 2020 and 2026. And Maine would get an extra 43 percent in funding over that same period.

Obamacare for me but not for thee is not a particularly compelling argument for either Collins or Murkowski, both of whom joined McCain in killing the Senate G.O.P.’s previous “skinny repeal” effort earlier this year. During an interview with CNN’s State of the Union on Sunday, Collins said it would be “very difficult” for her to support the Graham-Cassidy bill. And Murkowski has already promised that she wouldn’t vote for a bill that gives her state preferential treatment. “Then you have a nationwide system that doesn’t work. That then comes crashing down and Alaska’s not able to kind of keep it together on its own,” she said in July. Both senators are far more popular than Donald Trump, and neither would likely benefit by being known as the lawmaker that told the rest of the country to drop dead.

Other changes in the latest draft are even more cynical. While the repeal bill now includes sweeteners for Alaska and Maine, Senators Graham and Cassidy have also added concessions to far-right Senators Ted Cruz of Texas and Mike Lee of Utah, both of whom have also said that they are on the fence about the bill, if for the opposite reasons. According to Politico, the version of the bill circulating on Sunday night gives states greater leeway to roll back insurance regulations. That’s not particularly good policy: gutting out-of-pocket spending caps, for instance, could price individuals with pre-existing conditions out of the market. But it’s also bad politics: making the overall bill more conservative, while offering targeted exemptions for individual holdouts, seems likely to only alienate more moderates.

It’s a familiar predicament for Republican leadership, which has repeatedly found it impossible to craft a health-care bill that appeals to both conservatives and moderates within the party ranks. That schism was underscored over the weekend by perennial holdout Rand Paul, who has said that Graham-Cassidy’s block grants are still too generous. “The problem I have with block grants is that looks like I’ve affirmatively said I’m O.K. with 90 percent of Obamacare as long as we reshuffle it and give it to Republican states . . . That’s a horrible message,” the Kentucky senator said during an interview on Sunday. “Would I talk to them if they said they wanted to make the block grants half as much? I might.”

Paul’s position suggests that unless Collins and Murkowski abandon their principles—never discount grubbiness and hypocrisy!—the Republican caucus remains too far apart to move forward as one. The Congressional Budget Office is expected to release a limited analysis of the expected impact of the Graham-Cassidy bill on Monday. But with Republicans racing to vote on the legislation ahead of the September 30 deadline—after which point they would no longer be able to pass a health-care bill with a simple majority—the nonpartisan federal scorekeeper won’t have time to complete a comprehensive analysis of how the legislation would impact premiums before lawmakers cast their votes.

If they haven’t found a solution by the end of the month, Republicans will almost certainly be forced to work with Democrats to craft a bipartisan fix for the existing health-care system. The result, as McCain has suggested, would hopefully be to agree on a framework that wouldn’t collapse the minute a new party takes control of Congress. “The issue is too important, and too many lives are at risk, for us to leave the American people guessing from one election to the next whether and how they will acquire health insurance,” McCain said Friday in a statement announcing his opposition to Graham-Cassidy. “A bill of this impact requires a bipartisan approach.”